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Vol. 58, No. 5, 2012
Issue release date: August 2012
Section title: Regenerative and Technological Section / Original Paper
Gerontology 2012;58:463–471
(DOI:10.1159/000338095)

Virtualizing the Assessment: A Novel Pragmatic Paradigm to Evaluate Lower Extremity Joint Perception in Diabetes

Grewal G. · Sayeed R. · Yeschek S. · Menzies R.A. · Talal T.K. · Lavery L.A. · Armstrong D.G. · Najafi B.
aCenter for Lower Extremity Ambulatory Research (CLEAR), Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, Ill., USA; bDiabetic Foot and Wound Center, Department of Medicine, Hamad Medical Co., Doha, Qatar; cDepartment of Plastic and Reconstructive Surgery, University of Texas Southwestern, Dallas, Tex., and dSouthern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, Ariz., USA

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Article / Publication Details

First-Page Preview
Abstract of Regenerative and Technological Section / Original Paper

Received: 1/31/2012 9:19:37 AM
Accepted: 3/16/2012
Published online: 5/10/2012

Number of Print Pages: 9
Number of Figures: 4
Number of Tables: 3

ISSN: 0304-324X (Print)
eISSN: 1423-0003 (Online)

For additional information: http://www.karger.com/GER

Abstract

Background: Individuals with diabetes have a higher risk of falls and fall-related injuries. People with diabetes often develop peripheral neuropathy (DPN) as well as nerve damage throughout the body. In particular, reduced lower extremity proprioception due to DPN may cause a misjudgment of foot position and thus increase the risk of fall. Objective: An innovative virtual obstacle-crossing paradigm using wearable sensors was developed in an attempt to assess lower extremity position perception damage due to DPN. Methods: 67 participants (age 55.4 ± 8.9, BMI 28.1 ± 5.8) including diabetics with and without DPN as well as aged-matched healthy controls were recruited. Severity of neuropathy was quantified using a vibratory perception threshold (VPT) test. The ability of perception of lower extremity was quantified by measuring obstacle-crossing success rate (OCSR), toe-obstacle clearance (TOC), and reaction time (TR) while crossing a series of virtual obstacles with heights at 10% and 20% of the subject’s leg length. Results: No significant difference was found between groups for age and BMI. The data revealed that DPN subjects had a significantly lower OCSR compared to diabetics with no neuropathy and controls at an obstacle size of 10% of leg length (p < 0.05). DPN subjects also demonstrated longer TR compared to other groups and for both obstacle sizes. In addition, TOC was reduced in neuropathy groups. Interestingly, a significant correlation between TR and VPT (r = 0.5, p < 10–3) was observed indicating a delay in reaction with increasing neuropathy severity. The delay becomes more pronounced by increasing the size of the obstacle. Using a regression model suggests that the change in TR between obstacle sizes of 10% and 20% of leg length is the most sensitive predictor for neuropathy severity with an odds ratio of 2.70 (p = 0.02). Conclusion: The findings demonstrate proof of a concept of virtual-reality application as a promising method for objective assessment of neuropathy severity, however a further study is warranted to establish a stronger relationship between the measured parameters and neuropathy.


  

Author Contacts

Bijan Najafi, PhD
Interdisciplinary Consortium for Advanced Motion Performance (iCAMP)
Southern Arizona Limb Salvage Alliance (SALSA)
University of Arizona College of Medicine, 1501 N. Campbell Avenue
Tucson, AZ 85724-5072 (USA), Tel. +1 520 626 1349, E-Mail Najafi.Bijan@gmail.com

  

Article Information

Received: January 31, 2012
Accepted: March 16, 2012
Published online: May 10, 2012
Number of Print Pages : 9
Number of Figures : 4, Number of Tables : 3, Number of References : 33

  

Publication Details

Gerontology (International Journal of Experimental, Clinical, Behavioural and Technological Gerontology)

Vol. 58, No. 5, Year 2012 (Cover Date: August 2012)

Journal Editor: Wick G. (Innsbruck)
ISSN: 0304-324X (Print), eISSN: 1423-0003 (Online)

For additional information: http://www.karger.com/GER


Article / Publication Details

First-Page Preview
Abstract of Regenerative and Technological Section / Original Paper

Received: 1/31/2012 9:19:37 AM
Accepted: 3/16/2012
Published online: 5/10/2012

Number of Print Pages: 9
Number of Figures: 4
Number of Tables: 3

ISSN: 0304-324X (Print)
eISSN: 1423-0003 (Online)

For additional information: http://www.karger.com/GER


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